-Acute diarrhea is defined as less than 14 days of duration
-Persistent diarrhea is defined as more than 14 days of duration
-Chronic diarrhea is more than 30 days in duration
-Most of the causes of acute diarrhea are due to infections with virus and bacteria that are self limited
-Noninfectious etiologies become more common as the course of the diarrhea persists and becomes chronic
-Evaluation of noninfectious etiology should be considered when evaluation of bacterial, viral, or protozoa infections have been rule out
-The major causes of acute diarrhea include viruses (norovirus, rotavirus, adenovirus, astrovirus, and others), bacteria (salmonella, campylbacter, shigella, enterotoxigenic E. Coli, C. Difficile, and others), and protozoa (cryptosporidium, giardia, cyclospora, entamoeba, and others)
-Fever and peritoneal signs should be diagnostic clues of a possible invasive enteric pathogen
-Indications for diagnostic evaluation include: profuse diarrhea with signs of hypovolemia, passage of many small volume stools containing blood and mucus, bloody diarrhea, temperature of greater than 38.5 degrees C (101.3 degrees F), passage of greater than 6 unformed stools in 24 hours or a duration of illness greater than 48 hours, severe abdominal pain, hospitalized patients or recent use of antibiotics, and systemic illness with diarrhea, especially pregnant women
-Endoscopy may be necessary for determining the difference between infectious diarrhea and inflammatory bowel disease
-Management of acute diarrhea starts with management of hydration and alteration of diet
-Antibiotics should be avoided in patients with Enterohemorrhagic E. Coli
-C. Diff positive patients should have offending antibiotic stopped and consider starting metronidazole or vancomycin
-Listeria may present with diarrhea or systemic illness. If cultured should be treated with ampicillin and gentamicin or bactrim
-Loperamide can be used for the symptomatic treatment is patients with acute diarrhea who do not have a fever or bloody stool
-Probiotics are an alternative therapy that assist in recolonize the intestine with nonpathogenic flora
-Noninfectious Diarrhea-
-non infectious diarrhea can be caused by carbohydrate malabsorption, maldigestion, malabsorption syndromes, inflammatory bowel disease, ischemic colitis, radiation colitis, neoplasia, laxative abuse, post-cholecystectomy, vasculitis, drugs, poisons, disordered motility, neuroendocrine tumors, Addison's Disease, and Idiopathic secretory diarrhea
-Travelers diarrhea should be treated with antibiotics can be initiated after the diarrhea begins cipro 500 mg BID is given for 1-2 days
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